Provider Demographics
NPI:1447379607
Name:LIM, TERESA L (NP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:LIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2841 HARTLAND RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3500
Mailing Address - Country:US
Mailing Address - Phone:703-778-1800
Mailing Address - Fax:703-778-1803
Practice Address - Street 1:2841 HARTLAND RD
Practice Address - Street 2:SUITE 302
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3500
Practice Address - Country:US
Practice Address - Phone:703-778-1800
Practice Address - Fax:703-778-1803
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017001744363L00000X
VA0024057747363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAML1052795OtherDEA REGISTRATION